Wegovy Insurance Coverage: Balancing Costs and Health Benefits

Wegovy Insurance Coverage: Balancing Costs and Health Benefits

2024-03-13 20:58:44

It’s the eternal debate: charging basic insurance for treatments costs and weighs on premiums, but if it prevents other illnesses, in the end, we’re a winner, right? The question still arises, since March, regarding weight loss medications. Wegovy is now reimbursed, in the same way as the Saxenda and Ozempic equivalents, confirms the Federal Statistical Office to the SRF.

Prescription and insurance coverage is only possible for people who are significantly overweight or obese, i.e. approximately 11 to 13% of the population, according to the OFSP, which estimates the additional costs at insurance cost of around 100 million francs per year. The insurers don’t believe it. “We expect additional costs of at least 300 million per year if only 2% of all adults take Wegovy, and this does not include doctor’s fees and other treatment costs,” fears Matthias Müller of the umbrella organization Santésuisse.

Difficult to say who is right and to make plans on the comet. Because treating excess weight reduces the risk of subsequent problems, such as diabetes, cardiovascular disease or cancer. Quantifying how many costs will be avoided is almost impossible. It’s the reasoning that counts. Pharma is also adopting it, defending the (rising) cost of drugs for insurers by saying that they avoid more serious complications. It is the same thinking that pushed the OFSP to want to reimburse, from this summer, PrEP, a preventive treatment once morest HIV. Paying for care, in the long term, would cost less than treating HIV-positive patients.

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